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Respectful Insolence is a repository for the ramblings of the aforementioned pseudonymous surgeon/scientist concerning medicine and quackery, science and pseudoscience, history and pseudohistory, politics, and anything else that interests him (or pushes his buttons). Orac's motto: "A statement of fact cannot be insolent." (OK, maybe it can be just a little bit insolent.)

Active euthanasia in New Orleans: An urban legend in the making?

Via Kevin, M.D., I've learned of a news report in which it is claimed that doctors made the morally harrowing decision to kill patients in flood-ravaged hospitals with overdoses of morphine rather than letting them die in pain. The story Kevin cites seems to have originated from this article published in the British tabloid The Mail on Sunday and then to have spread thoughout the British, Canadian, and Australian media. It tells a harrowing tale, which has been commented on by Majikthise and Pandagon, among others:

With gangs of rapists and looters rampaging through wards in the flooded city, senior doctors took the harrowing decision to give massive overdoses of morphine to those they believed could not make it out alive.

In an extraordinary interview with The Mail on Sunday, one New Orleans doctor told how she 'prayed for God to have mercy on her soul' after she ignored every tenet of medical ethics and ended the lives of patients she had earlier fought to save.

Her heart-rending account has been corroborated by a hospital orderly and by local government officials. One emergency official, William 'Forest' McQueen, said: "Those who had no chance of making it were given a lot of morphine and lain down in a dark place to die."

Given the horrific conditions in some New Orleans hospitals three days after the hurricane, the story certainly sounds plausible on the surface. Conditions were harsh in New Orleans hospitals for a few days before relief came. There was no power, no running water, and flooding of the lower floors of all but one hospital. And, yes, there were armed gangs of looters threatening to break into some hospitals. But something--I'm not sure what--set my skeptical antennae twitching. Something about this story definitely seemed fishy to me.

As I thought about it more, my misgivings multiplied. Yes, it is very likely that doctors probably were forced to do some form of disaster area triage, deciding which patients had a decent chance of making it and which didn't, and then making decisions accordingly about who would be treated and/or transported first. However, as a physician myself, it didn't ring true to me that these doctors would be quite so cavalier about devoting so much of their precious stocks of morphine to euthanize "hopeless" cases when there were undoubtedly many salvageable patients who needed pain medicine and no new supplies of drugs could be anticipated any time soon. In addition, as The Well-Timed Period points out, if all the narcotics were in a state of "lockdown" because of fear of armed looters and drug addicts breaking into the hospital (as claimed in the story), then how did one doctor get so many doses of morphine to use without attracting a lot of attention from nurses and her colleagues? And if it weren't just one doctor doing this, then why were there apparently no discussions or arguments about this, which would have been hard to keep secret? Killing our patients is not the sort of things that we doctors would all agree on, no matter how extreme the circumstances or how morally justified some might consider it under the circumstances. Individual practitioners would likely have strong and varied opinions about this issue. Finally, even if such passive euthanasia did occur, it seems unlikely that a doctor would talk about this to the press, particularly so soon afterward, with the disaster recovery still very much under way. This unnamed doctor would, under Louisiana law, be admitting to murder. It seems unlikely that any doctor who had actually committed such an act would want to take the chance of drawing attention to what she had done by blabbing to the press, with the attendant risk of the police identifying her. She would also be increasing the pain of the surviving relatives.

I decided to look into the story a bit more last night. Most interestingly, I Googled this William "Forest" McQueen described in this story. (I only wish I had clicked on the link in the piece in The Well-Timed Period before; ema had already done the Googling for me.) I could find nothing on the web about him other than this article from the BBC News Service:

Mother-of-two Suzanne McQueen, of Maidstone, Kent, is waiting for news of her American husband (William) Forest McQueen.

He has been working in his home country since 1997, and lives and works with his brother in the Abita Springs area, north of Lake Pontchartrain, which is north of New Orleans.

The couple married in the UK in 1991, and Suzanne said she and her daughters - aged 11 and 13 - were planning to move to the US to join her husband as soon as was possible.

Mr McQueen's wife has had no news from his friends and family. Part of his job there is to maintain the grounds of an old plantation house, she said.

"I phoned the morning the hurricane hit, and his brother said Forest hadn't been home for the last 24 hours because he'd been on shift clearing up trees and lines from all the wind damage that came before the hurricane. I haven't heard anything since.

This only named source cited in the article was a utility manager whose job it was to maintain the grounds of an old plantation house? He and an unnamed intern were the corroboration for this doctor's story?

But that wasn't the most dubious part. This part of the story sounds even fishier:

Mr McQueen, a utility manager for the town of Abita Springs, half an hour north of New Orleans, told relatives that patients had been 'put down', saying: "They injected them, but nurses stayed with them until they died."

This McQueen guy told relatives that their loved ones had been "put down"? What a compassionate, diplomatic guy! And, if nurses stayed with these patients, why was it that the only sources they could find to corroborate this unnamed doctor's story were an unnamed orderly, unnamed "government officials," and this guy, whose responsibility (if any) in the chain of command is not reported? How would he be in a position to know? Had he gone into New Orleans itself, or had he just been working in Abita Springs? After all, the worst conditions reported were within the city of New Orleans itself. Or were there armed gangs of thugs threatening hospitals the Abita Springs area? Why is Mr. McQueen the only named source?

I don't discount the possibility that this story may turn out to be true, given the brutal conditions in some New Orleans hospitals in the aftermath of the hurricane. Indeed, it could be true or an exaggerated account of what really happened. However, I have not been able to find any independent account to verify that this did happen that doesn't appear to be a variation of the original Mail story, and the three accounts there are as of this writing are riddled with claims that sound dubious to me. In the absence of independent corroboration, I must withhold judgment and consider the account unlikely to be true. What is unfortunate to me is the very credulous response that this story has received in the blogosphere, with lots of outraged or sad posts referencing the story but not one that I've been able to find (other than the one at the Well-Timed Period) expressing skepticism stronger than the "I'm not sure how reliable this source is" variety. Even the Bioethics Weblog commented on it without a whiff of skepticism, even though some of my concerns should have set off their skeptical antennae as well.

There's nothing about this yet on Snopes.com, but, if this story does turn out, as I think likely, to be an urban legend, it still brings up some difficult moral and bioethical questions, as J Train at Majikthise pointed out. Yet one has to ask, what chord did this story strike that caused it to resonate so? I think one possible answer is, oddly enough, contained right in the original story itself:

Their families believe their confessions are an indictment of the appalling failure of American authorities to help those in desperate need after Hurricane Katrina flooded the city, claiming thousands of lives and making 500,000 homeless.

The response to the Katrina disaster was so ineffectual initially that it is very easy to believe that doctors would become desperate enough to consider such an act. In such an environment, a story like this can gain a traction that it might not have gotten otherwise, had the government response been more swift.

Comments

Does anyone still use that term, "orderly"? It was a little thing, but the first red flag for me. It is anachronistic, like seeing nurses in white caps.

Also the idea that, per the elusive McQueen: "Those who had no chance of making it were given a lot of morphine and lain down in a dark place to die."Lain down in a dark place? Why dark? Why move people? Such little details, which may make a tale more plausible to casual listeners, make me suspicious.

I also have seen circulated a tale of how only one person was euthanised in a particular hospital, when the health care workers just could not move him down the stairs and out, because he weighed 380#. So the unnamed "female manager" at the unnamed hospital "ordered that he be given euthanasia" and said "we're going to help him to heaven", as reported by an unnamed bearded doctor surrounded by his unidentified collegues. That report was in Scotsman.com and nowhere else I could find (except as it was repeated and reprinted from the Scotsman site).

I think the idea of active euthanasia and "mercy killing", voluntary and not, is going to be a big part of the legends that come out of this disaster. Part of the horrified-fascinated storytelling that is part of coping mechanisms.

Some background on The Daily Mail/Mail On Sunday that may influence your reading of this article...

A typical issue of the Daily Mail will include:

1. An article on how X* is reaching EPIDEMIC proportions and that everyone in Britain WILL DIE, usually extrapolated from a graph with just two data points on it, or from a quote like "If trends continue at the current rate and we don't stock up on medicine and people aren't immunised and there's a general strike and we're just really really unlucky, then there is a small chance that X may reach epidemic proportions."

2. An article about how Britain is being FLOODED by ILLEGAL IMMIGRANTS who TAKE OUR JOBS or set up GANGS to sell DRUGS to children.

3. An article about how a celebrity lost lots of weight.

4. A feature on an alternative therapy such as homoeopathy, crystal healing, reiki etc etc etc.

Often the story themes are combined, so you will find an article about a celebrity who lost weight through ayurvedic medicine, or how illegal immigrants are spreading athlete's foot.

But I digress...

My point is that if I were ever unfortunate enough to find myself with nothing else to read but the Daily Mail and I read an article like the one you refer to, I would take it with a pinch...no, a handful of salt. In fact, I'd take that salt and dissolve it in water, then take a drop of that solution and drop that in more water, and repeat enough times that there are no salt ions left (as we all know that that is when salt is at its most potent) and only then would I feel comfortable.

It's a great blog you've got here, by the way. Keep it up!

Ecks

* For X, open a medical textbook at a random page and pick a word...over the last few years they've "reported" on SARS, Asian flu, meningitis, CJD, ebola and that flesh-eating disease

Yeah, it's possible I got taken in by an urban legend, but like I said in my commentary (at Majikthise), I'd be surprised if this didn't happen at some level somewhere in the area. It is a bit surprising that people would be so forthcoming about it. Anyway, it was an interesting topic.

Skeptyk...yes, some people (especially the older and Southern) still use the term "orderly".

Sounds to me like the Daily Mail is over-dramatising the decisions that any doctor would have to make under these conditions. You treat the ones that have a chance of surviving and do your best to relieve the suffering of those who don't. You can't save everyone, no matter how much you want to.

In fact, the quote from McQueen seems to support this. Unless he knows the difference between fatal and non-fatal doses of morphine, I doubt if he could tell whether the doctor was actively euthanizing or simply doing her best for someone in a hopeless situation.

Many of us in the New Orleans area are hearing the rumors, but I have heard nothing that could substantiate anything but that the staffs at various medical centers were nothing short of heroic in carrying out their duties. Fortunately, an early rumor that staff and patients alike all drowned at Chalmette Medical Center turned out to be false, but the true tales are harrowing enough. This morning’s Times-Picayune reported on the death of 35 patients at Memorial Medical Center as well as the valiant efforts of the staff there. You can read the whole piece, entitled “Hospital staff fought to save dying patients: 45 bodies protected from water, looters” at http://www.nola.com/newslogs/tporleans/index.ssf?/mtlogs/nola_tporleans/archives/2005_09_13.html#079197.

The problems at most hospitals in New Orleans were compounded by the fact that emergency power supplies were housed on the first floors of the physical plants (in the basement in the case of Charity Hospital). One of the reasons Ochsner is still up and running is that their generators are on the fourth floor.

Not that this makes the story any less probable than it already is but...

I understand that an overdose of painkillers can be lethal, but why use valuable morphine to euthanize patients when it could be more useful elsewhere? Why not use an overdose of anesthesia drugs instead (the common practice in vet clinics- as far as I'm aware) and save the morphine for its intended use. It would make more sense, in my opinion (and if the story were indeed true), since I find it unlikely that any major surgeries (at least the non-emergency types) would be performed during an evacuation.

When performing an emergency move of patients in any volume, I would think pain medications would be a top priority- to ease the stress of the move.

For me, it's because of the types of people who are cavalierly and irresponsibly posting this story as if it were corroborated fact, and because of the types of people who are buying it and latching on to it so quickly that I just don't believe it. There's no hard news on this, no serious research, no legitimate corroboration, nada, nothing, zilch. But that's the way of the blogosphere - create hysteria where there is none, and see if it'll get ya a few more hits and a little more attention.

Oddly enough, my attempted debunking of this story hasn't seemed to have gotten me much in the way of any more hits than I usually get. Maybe a small uptick, but it could just be noise.

But you're right. The vast majority of the commentary on this story is credulous in the extreme. It's also mostly coming from left because such a story makes an easy lead-in for criticizing Bush. It just goes to show that the right doesn't have a monopoly on credulity.

I didn't mean you - I think you've done a great job objectively analyzing this highly specious story.

Actually, I'm finding more references to it on the conservative religious blogs. They're using it as a springboard for all kinds of prolife messages. Not to get into a prolife debate, but you'd think someone who was interested in the genuine sanctity of life would be careful not to spread what could be seen as slanderous. If enough people believe this, then every physician and health care worker coming out of New Orleans will be looked upon with suspicion.

Just wanted to follow that up with what should be obvious -- if enough people believe this, it will be because they read about it at places like Happy Catholic, who are presenting it as fact. This is the problem with people who act like journalists on the internet, but aren't really journalists. There's a protocol one follows before reporting a story, and reliable corroboration is the very first thing one looks for, especially with stories that are potentially harmful to any group of people. Yet these religious types, for all their yammering about morality and sin and responsibility, see something like this and salivate over it because they can use it to make their point, and all of a sudden forget about all that morality and sin and responsibility. It's wrong. It's so unethical.

Actually, she only included that disclaimer the next day after someone included a link to this post in her comments boxes and pointed out that the story is unlikely at best. Until then, she was "happy" to run with it as truth.

That's the problem with the "blogosphere". People are living inside this weird little bubble where they find like-minded people who parrot all their own freaky little weirdnesses and beliefs, and they all thrive off each other, looking to each other for validation, and are subject to no outside scrutiny. Mix a few oddball stories into that incestuous little atmosphere, and next thing you know, the line between fact and fiction has been blurred some more for yet another segment of the population. It's a creepy, unhealthy trend, and I think these bloggers ought to be held responsible for what they write, or for the stories they spread.

OK, true or not it raises some interesting bioethics questions related to how to treat people in dire circumstances, how to use scarce resources (including transportation resources), and how what is prohibited normally may still be prohibited but potentially (and I'm not advocating this) less blameworthy given the circumstances. The irresponsiblity of journalism aside (and I don't mean to belittle that aspect of it), what do others think about these dilemmas?

Fox News had their own reporter recounting the story, which is where I first heard it--not that that greatly augments its authenticity.

As for Dee's comment that "There's no hard news on this, no serious research, no legitimate corroboration, nada, nothing, zilch. But that's the way of the blogosphere - create hysteria where there is none, and see if it'll get ya a few more hits and a little more attention."

This story originated in the media, not in the blogosphere, and the media should be investigating, corroborating or debunking it, as you will. It's the role of the blogosphere to push them to do it.

The entire article is best seen as skewed through the prism that yielded this line:claiming thousands of lives As we now know, fewer than one thousand lives were lost. Makes quite a difference, don't you think?

I was about to post a comment pointing out the ethical issue regarding exactly what I found Anonymous writing about. Did the "put down" really happen. Based on thoughtful consideration and Orac's investigation and that of others, probably not. But to an ethicist.. but also to all of us in society, we shouldn't ignore the issue even if a hoax. The point is-- given the circumstances of the disaster--it COULD have happened. It is not unreasonable to think that it could happen. So.. the ethical question is could the act of terminating the life of a terminally ill patient under these conditions be an act beneficence to the patient and have mitigating circumstnces as a legal defense? This question is not theorethical or foolish and can't be excused because the story is a hoax. It must be answered by society.. and the answer is.. ..Maurice.

The whole thing is crazy. What's the deal with supposedly moving the dying to a "dark area"? I thought the power was out. Wasn't the whole place pretty dark? I have the same skepticism about this story that I have whenever I hear that some "brave doctor" has come forward, usually in support of physician-assisted suicide, to claim that he has personally, purposely administered lethal doses of morphine to his patients; the defiant, old defender of his hapless patients who just want their suffering eased, blah, blah, blah. William F Buckley referred to this supposed practice once in National Review and said that "kindly nurses look the other way". Right. And who withdraws and accounts for the narcotics these kindly old Marcus Welby's use? In 24 years of working as a nurse I have never seen it and don't expect to. A person who is actively dying would not require all that much morphine to ease their discomfort before they passed if they were not already accustomed to large doses of the stuff. The story is obviously a sham.

When I first saw this story, I forwarded it to a level-headed RN friend who's been volunteering in the NO area since a few days after Katrina hit.

The response: Probably true, i heard from a neonatal nurse at the hospital i was at seveal days ago a similar story of 20 premie babies at one hospital that were abandoned when the helecopter had no oxygen to transport them. Awful, but reality in a disaster. The NICU at my hospital had babies from Charity Hospital that survived. ...

Orac is but a humble pseudonymous surgeon/scientist with an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his miscellaneous verbal meanderings, but just barely small enough to admit to himself that few will. That Orac has chosen his pseudonym based on a rather cranky and arrogant computer shaped like a clear box of blinking lights from an old British SF show whose special effects were renowned for their early 1980's BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction for television ever produced, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.) Orac tries to keep his insolence respectful, but admittedly sometimes fails in the cases of obvious quackery and pseudoscience, attacks on him, very poor critical thinking skills, bigotry, and just general plain stupidity.